gold usmle: cardio pharm Flashcards
Digoxin
↓ AV nodal conduction/ inh. Na/K/Atpase = inc. Ca conc. in heart cells = inc. contraction force
Diltiazem
Txt black men. Txt AV nodal re entrance
Quinidine
↓ AV nodal conduction. Cinchonism. Anticholinergic= aggravate MG. Hypotension= α block
Verapamil
↓ AV nodal conduction. ↓ BP. Negative inotrope= no CHF use
Propranolol
↓ AV nodal conduction. ↓ BP. Negative inotrope(= β block) Aggravates Asthma and Diabetes Melitus via β2 block.
Diazoxide
Balanced vasodilator.
Niroprusside
Balanced vasodilator. Unloads heart. ↑s cyanide= pre-txt w/ thiosulfate. Txt Acute HTNv Crisis
Reserpine
Txt severe & resistant HTN. Depletes CA. See stuffy nose. No to pts w/ peptic ulcers.
Dobutamine
At high doses β2(+) offsets α1 = β1 ↑ CO w/o systemic vascular resistance
Dopamine
At low doses Txt Shock= dilates renal and mesenteric aa= maintain urine output
Esmolol
Short acting β(-)
Captopril
Balanced vasodilator. Txt Outpt. CHF see dry cough(bradykinin induced)
Digoxin
Txt CHF & Atrial Flutter - inotropic - ↓ K+ levels= dig. Toxicity
Dig. Toxicity
Fatal ventricular arrhythmias w/ sever AV block
Quinidine
ClassIa anti arrhythmic. Moderate Na Ch. Block
Lidocaine
ClassIb anit arrhythmic. Normalizes conduction. Txt initial MI= control arrhythmias
Flecanide
ClassIc anti arrhythmic. Marked conduction slowing
Amiodarone
Long t1/2= need potent doses to obtain desired level for action. See blue skin, ocular deposits, Pulmonary Fibrosis.
NE
↑ AV nodal conduction via β1. Metoprolol(-) β1
Ach
↓ AV nodal conduction via M receptor. Atorpine(-) M-r
Atenolol
Controls catecholamine induced arrhythmias
Bretylium
Txt Malignant Ventricular Arrhythmias but causes passing catecholamine release that can aggravate arrhythmias
briefly
Nimodipine
Txt Acute subarachnoid hemorrhage by preventing post hemorrhagic vasospasm
Atropine
↓ excess vagal tone as seen in Sinus Bradycardia
Nitrates
↓ preload= venous pooling. ↓ MVO2= reflex tachy. ↑ ventr work= dec O2 demand
Propranolol
Blocks reflex tachy but causes excess brady= ↑ diastole time= ↑ EDV
Verapamil
↑ O2 supply via ↓ in vasospasm Txt Prinzmetals variant angina
Aspirin
Prevents arterial platelet adhesion (not DVThrombi). Inactivates COX= ↓ platelet production of TxA2, a potent
vasoconstictor
Warfarin
(-)Vit. K dependent gamma carboxylation of clotting factors= anticoagulation state
Heparin
Dependent on Antithrombin III activation
TPA
Binds to fibrin clots & activates plasminogen on the spot. Short t1/2, given IV.
32. Does not discriminate b/t fibrin-based clots= bleeding & stroke complications arise
Streptokinase
From bacteria= allergies arise. Can see excess bleeding in post-op pts.
Urokinase
Human source. ↑ plasmin. Can see excess bleeding in post-op pts.
Colestipol
Bile acid sequestrants. Interrupt bile acid reabsorption= ↑↑ LDL uptake. Cholestyramine same MOA.
Lovastatin
HMGCoA reductase(-)= ↑ LDL-r synthesis. Pravastatin/ Mevastatin same MOA.
Losartan
↓ Aldosterone. ↑ Renin 2-3xs
Diazoxide
Txt insulinomas. Not balanced vasodilator= onlt dilates arterial smooth muscle
Clonidine
Central α2(+). ↓ TPR via ↓ symapthetic effect
Methyldopa
Central α2(+). (++) Coombs= Hemolytic anemia
Phenytoin
ClassIb. Reverses mild AV block due to digitoxin toxicity
Procainamide
ClassIa. SLE like syndrome.
Indopamide
Only Thiazide that will have no effect on cholesterol levels
Thiazides
Older black men w/ HTN due to ↑ Renin.
β(-)
Young white men w/o asthma (cause bronchospasm)
ACEIs
(-) change AI ! AII. (-) Bradykinin inactivation. Captopril/ Enalapril
47. Cause renal failure = use w/ caution in the elderly
Epinephrine
↑ contraction rate & force via β1.
- ↑ systolic but ↓ diastolic BP.
- ↓ peripheral resistance via β2 vasodilaiton
Norepi.
↑ heart rate and ↑ systolic and diastolic BP
52. ↑ peripheral blood vessel resistance
Methyldopa
DOC for pregnancy induced HTN
Quinidine pre-txt
Atrial arrhythmia pretxt w/ a drug that will ↓ ventricular response: Dig.;β(-); Ca Ch.(-)
ClassII
β(-) ↓risk fo reinfarction & sudden death following MI
Gray man
Amiodarone: ClassIII antiarrhythmia
Beperidil
Ca Ch(-). Limited clinical use due to Torsades de Pointes
ACEIs
Vasodilate renal efferents > than afferent arterioles: ↓GFR & Filtration pressure
59. ↓ Diabetic renal failure progression
Adenosine
Its receptor is blocked by Methylxanthines (ie Theophyline)
61. Favored for the Txt of Reentrant Supra Ventricular Tachycardia
Enoxaparin
Low molecular weight heparin = Oral anticoagulant
Isoproterenol
↑HR & ↓MAP
Variant angina
Use Ca Ch. (-)r ie Nifedipine
Contraindicated in
CHF
β (-)r = you dont want to ↓ the hearts pumping strength